Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for North Sydney proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The need to provide the most vulnerable Australians with practical access to adequate health services.

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

Dental disease is a grave problem for many poorer Australians. Thirty per cent of Australians avoid dental care due to cost and 20 per cent avoid treatment specifically recommended because of cost: 25.5 per cent of Australians have untreated dental decay; one in six Australian adults are limited in what food they can eat because of their teeth; and 50,000 Australians are hospitalised each year with preventable dental disease.

Dental disease is most prevalent in poor and disadvantaged people who, I might say, stood to benefit the most from our Medicare dental rebate scheme, the scheme that the Labor Party has now abolished in the dark of night with a press release—only on a departmental website rather than on the minister’s website itself. Statistics show that people with higher incomes are more likely to see dentists for preventative services such as scale and clean, while poorer people need more treatments.

For diabetics, people with heart disease and particularly those with HIV-AIDS, dental disease makes the illnesses worse. Cancer treatments can affect the teeth and gums. People with tooth abscesses and cracked teeth are often in chronic pain and may not be able to see a doctor. And, of course, tooth pain can stop people from eating properly and cause malnutrition. Some medications also affect teeth. Being elderly and having problems with arthritis in your hands or having dementia can affect your ability to clean your teeth properly, making dental problems worse.

It is true that in 1996 the then coalition government refused to continue with a lapsing federal government program which was assisting the states in helping to address the backlog of people waiting for dental treatment at hospitals. The strong view taken by the previous government was, given that it was the financial and policy responsibility of the states to provide dental services, those states had an obligation to fulfil their obligations to individuals, particularly those most in need.

When we had the capacity in the budget to provide additional services, the government of the time responded. That is why a scheme was introduced by the Howard government, which commenced in November of last year, where individuals could receive treatments of up to $2,125 per year or $4,250 over two years. There were no restrictions on what the dentist could do; it was just work up to that value. It was an identifiable Medicare item number—a Medicare rebate that was available for those people most disadvantaged by severe dental problems. For the first time Medicare accommodated the needs of those individuals. Those individuals went to see their doctor, their doctor put in place a proper program to assist with the management of the dental problem, they were then referred to a dental specialist or a dental prosthesist—of the choice of the patient—and that treatment was provided, up to a value of $4,250.

The so-called caring, compassionate Rudd government abolished that Medicare rebate for dental services. They did not do it on the day that they had their smokescreen about teen health, whereby, if the government provides a $150 voucher, the teenager has to find another $150 to match the money. They did not explain that, in fact, this so-called ‘teen voucher’ actually does not deliver any dental services other than a check-up. So if the dentist finds there is a problem, well, it is over to the teenager to fix it.

Their total commitment thus far to the dental health of the most vulnerable Australians is a $150 copayment voucher for teenagers to get their teeth checked. In contrast, it was the Howard government that put in place a Medicare rebate of $4,250 so that those people most vulnerable could get their teeth fixed—not a check-up or a consultion. There was no committee set up. There was no 2020 summit. It was a real outcome that relieved the pain of the individuals, the severe chronic pain of the individuals, when state Labor governments had let them down—state Labor governments with queues that wait for years to be provided with dental treatment.

The state Labor governments let them down. The federal government came in to pick up the pieces with the Medicare rebate. And what is the first thing that the Rudd government does for those people who are the most vulnerable? It cut the Medicare rebate and put in place a system that provides no dental treatment. I say to the minister, through the Speaker: there are real people behind this. One of them is Mr Chris Planer. I quote from the Sydney Morning Herald of 12 March:

Chris Planer, who lost his nose to cancer, has experienced the health system’s lack of logic.

He has undergone life-saving surgery at no financial cost.

               …            …            …

Three years ago, Mr Planer, 28, was diagnosed with ... carcinoma in the floor of his nose and roof of his mouth.

The result was a 16-hour operation ... Then, in the same marathon procedure, plastic surgeons reconstructed his face ...

Mr Planer also required chemotherapy and radiotherapy – which triggered the need for further plastic surgery. The radiotherapy had burnt a hole in the top of his new nose.

The article continues:

... the fierce anti-cancer treatment has damaged his dental nerves. This, along with the impact of a plate in the roof of his mouth, means he needs monthly visits to the dentist.

The treatment he received has made his teeth more vulnerable to decay and more likely to need expensive root canal treatment.

That routine can run into hundreds of dollars a month ...

Mr Planer and his wife have just had a young baby, William, and they are wondering why the $4,250 plan and treatment that has been provided by the federal government has left them with no options at all. This government has abolished that plan. What does the minister for health say to Chris Planer—a real person who has had cancer treatment, who has severe dental issues and who now has nowhere to go as a result of the abolition of the Medicare rebate by the Rudd government? This is fiscal conservatism?

We wonder what the government’s motives are when they attack carers. We wonder what their motives are when they attack pensioners. We wonder what their motives are when they attack Chris Planer and people like him who have severe dental problems. Do you know what this is? It is the Prime Minister trying to be a fiscal conservative. We are about to have the mother of all surpluses in Australian history and the Prime Minister—who has taken his eye off the ball on the micro detail of running the country so that he can head off overseas and swan around the Pacific—leaves carers and pensioners behind, with huge amounts of anxiety. They have been abandoned by his government. Now we find by going to the departmental website that a Medicare rebate service that in just two months provided 16,000 people with dental care that they never had previously has been abolished.

We know that the government is pretending to be something that they are not. They are heartless. They do not care about the individuals out there. They preach compassion, but they are trying to parade as fiscal conservatives. Fiscal conservatism comes not because you are heartless but because you make long-term decisions in the best interests of the nation. It is about standing up for the principles that beat in the heart of every Australian. They are principles such as compassion for those most vulnerable and support for those people who cannot support themselves—people who are the victims of injustice. It is not about picking on those people; it is about supporting them. It is about rewarding individual effort and about providing incentives for people to earn a buck when they want to earn a buck. It is about growing the pie rather than fighting over the share of the pie.

The new member for Dobell on the Labor Party side of the parliament belled the cat today. Mr Thomson is quoted in today’s paper as saying:

There are children in our suburbs who are living in pain because their parents cannot afford their dentist bills ... There are elderly people who do not go out because they are embarrassed about their chronic teeth problems.

These issues should have been addressed by the state Labor government. It failed to address them. The Howard government introduced a $4,250 rebate to help these people specifically, and one of the first things that ‘Old Chopper’ Roxon does is chop out the Medicare rebate for those who are the most vulnerable.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for North Sydney will refer to ministers appropriately.

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

As the member for Dobell said, he is going to fight for ‘dental under Medicare’. Amen, I say to the member for Dobell. But he should have said that one, two or three weeks ago or before the election. He should have said, ‘I’m going to fight to keep dental under Medicare.’ He does not need to fight us about it. He does not need to fight Medicare about it. He does not even need to fight those who are vulnerable in his community about it. He needs to fight the minister and the Prime Minister—the same two people who have taken away real treatment—not consultation—that addresses dental problems for those who are the most vulnerable.

It is no wonder that Dr John Matthews, President of the Australian Dental Association, said that the Labor Party’s approach is ‘patchy’ and ‘piecemeal’. It takes a lot of courage for representatives of non-government organisations to speak out only three months from a change of government. It takes a lot of courage for individuals to do that. Dr John Matthews said that the approach of the new government is patchy and piecemeal—and I am sure that behind the scenes he is a little more effusive in his criticism.

It is the practice of this government to run a smokescreen. It is interesting, isn’t it, that they say one thing and do another? They say, for example, in the glossy press release with a happy smiling Prime Minister and a happy smiling minister for health at the top that they are providing $360 million over three years to the Teen Dental Plan. Then, in what can only be described as a dour press release that sits on the departmental website, they kill off the Medicare rebate.

Of course the Labor Party continue to be damned by their own words. The best illustration of this is private health insurance. Hypocrisy be thy name, Minister. We remember that, only a year ago, the Minister for Health and Ageing—the minister at the table—said that an increase in private health insurance premiums that was higher than inflation was not good news. A year ago the minister said that a 4½ per cent increase was an issue that justified holding the government to account. She said that a 4½ per cent increase was outrageous and that it was going to have an impact on ‘working families’. However, the first decision she makes in relation to private health insurance is to approve a five per cent increase, which is higher than inflation and higher than health inflation.

This is hypocrisy of the Rudd government. This illustrates what they do: they say one thing and they play cute games—be it on carers, on pensioners, on those people most vulnerable—or on Chris Planer. They are playing with the hearts and souls of those who are most vulnerable, and they are doing it because they want to pretend to be fiscal conservatives. Minister, I say to you: if you want to be a fiscal conservative, protect those who are most vulnerable and stop wasting government money on initiatives such as the Tree of Knowledge, which is a dead tree that the Labor Party is spending $2 million on, or a dinosaur museum, which the Labor Party is spending $1 million on. Do not leave those who are most vulnerable alone. Put in place a dental scheme that helps those people with the most severe dental problems. (Time expired)

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

I thank the member for North Sydney for raising this matter. It is disappointing that other members are leaving because I am going to take the shadow minister through exactly what is happening with dental care. I found a quote that he gave not that long ago to the Medical Observer about taking on the role as the shadow health minister. He, rather frankly—and I totally understand; when I became the new shadow minister I had this feeling as well—said that he would ‘ask the stakeholders forthright questions about things I neither understand nor am fully informed about’. Fair enough, but what is clear is that he neither fully understands nor is fully informed about the government’s approach to dental care.

I am going to take him through exactly what we are doing and why, because I understand many people in the community are affected by this decision. I understand and very much sympathise with the position that the shadow minister raised of the individual who has had cancer and a whole range of treatments, none of which, I might add, would have been covered by the government’s dental program.

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

Yes, they would have.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

The shadow minister is quite wrong. Cancer treatments and the other treatments are not covered by the dental program. I am going to take the shadow minister through the government’s reasoning for closing down the dental scheme. Let us get a couple of things straight. The shadow minister alleges that this program has helped 16,000 people in two months—wrong. This program has helped 15,000 people in four whole years.

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

No, no, no.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Yes. I hate to tell the shadow minister that these figures are available. They have been released. They were released by the previous minister. This program helped 15,000 people in four whole years, including not a single child or person under the age of 24 in the Northern Territory and not a single child under the age of 14 in South Australia. I can go through example after example. I listened to the shadow minister attentively for a period of time and I am trying to answer his questions, because I think there is a legitimate debate about the way we provide dental care to the community. I want to take the shadow minister through why the decision was made to close down a failing program that, we understand, helped some people—and we do not pretend that it did not.

The problem is that it was not a targeted program, it was not a successful program and—a point that was made by the shadow minister—the poorest people with the worst health did not get access to it. If you were simply poor and had bad dental health because of your poverty, because you could not afford to go to the dentist, you could not get treatment under this program. If you were extremely wealthy and had a serious chronic disease, you could get access to this program. It was not targeted. It did not help those most in need.

We agree that it helped some people, but we made a decision, as governments need to, about the way we can help the most people. The shadow minister will need to get into his head—because no doubt we will be debating this for months to come—that our $650 million program has two components to it that will be targeted particularly at those people whom he alleges the opposition is worried about: the poorest with the worst dental health, who are those in most need of support.

Our program has two parts. The part that the shadow minister wants to focus on is the $150 for teenagers—about 1.1 million or 1.2 million teenagers will be eligible for this. It is a component of Medicare. It is paid under a teen dental scheme program. It is going to ensure that we encourage people before they have serious dental problems. Of course, we know that some people have serious dental problems earlier on, but the majority get their problems later in life. We are going to encourage teenagers to care for their teeth properly—to get annual check-ups. We are going to try to ensure that they maintain their teeth in good condition by investing early on so that any problems that might arise do not get worse further down the track. That is one important down payment where we are investing in preventative care. We are going to improve people’s health long term and we are setting up infrastructure under Medicare that allows people to get their teeth checked.

The second important part of our program, which the shadow minister totally ignores, is the $290 million which is going to re-establish the Commonwealth Dental Health Program. In consultation with the states—the sum of the details is still being worked out—it is going to ensure that those who are the most needy, the poorest in our community with the worst dental health, will get the assistance they need through our public dental services.

The shadow minister can come in here time and time again—as we heard those opposite do when they sat on this side of the House—and criticise state governments for not being able to deliver the dental care that so many people in the community need. We agree that they need to do better but, unlike the previous government, we are prepared to do our bit in helping them to do better. They service the poorest of the community, they service the concession card holders and they service kids. They are often the only people in the community who treat people with the most chronic conditions. There will be examples here and there of people who benefited under the previous government’s program, but there will be many more millions of people who will get assistance under our program, which is better targeted, is means tested and is going to provide services, particularly to children, who so spectacularly missed out under the previous government’s program.

Let me just make the point—and I have made it in the House before—about the Northern Territory: we know that we have some of the poorest, most marginalised people in our Indigenous communities in the Northern Territory and they have some of the poorest dental health outcomes. This program over four years—and I wonder whether anyone on this side of the House can guess how many people in the Northern Territory got assistance under the previous government’s program in four whole years?

Government Members:

Government members interjecting—

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

It is hard to guess because everyone on this side of the House already knows that no-one under 24 got assistance. Not a single child born during the period of the Howard government got any assistance during the period of the Howard government—not a single child.

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

Mr Hockey interjecting

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

The member for North Sydney was heard in silence.

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

Mr Hockey interjecting

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

And the member for North Sydney is under a warning.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

The member can be assured that these figures are current as of January 2008, so there is only one month of data that is not yet available. In four years to January 2008, 17 people only in the whole Northern Territory got help from this program. We know that hundreds of thousands of people will get help from our program in its very early days.

Of course there are difficult choices. Of course there are some people who will be disadvantaged. But we have made a decision that assisting probably two, three or four million Australians to get better dental health care over the period of this commitment and to get good preventative care, which makes sure that they do not have more severe problems later in life, is a good investment for our money. We are not afraid of that, and we are not walking away from that.

There is a question, however, that I know some members on this side of the House want clarified. This has been made publicly available. This was not in the dark of the night; this has all been announced. Any of the people who are currently receiving assistance under the previous government’s program will be able to continue to complete their treatment until 30 June this year. We are making sure that people who have been referred by their doctors to their dentists, who may have already had some teeth removed and who may be waiting still to have restorative work done, will be able to have that work completed by 30 June. We have notified the dentists. We have notified the doctors. We have had advice from the dentists that a three-month close-down period is an adequate amount of time for people to receive their treatment.

As of 30 March this year, new people will not be able to enter the program. This was an election commitment. We were elected clearly stating that we would close this program and institute what we think is a better targeted program which is going to help more people and particularly help more people who cannot get to the dentist because of cost. We make no apologies for doing that.

So I do not want to come in here and be lectured by an opposition who did nothing about dental care for 11 years, who at the last minute decided to introduce a program which was a spectacular failure, not servicing those people in the most need, and who then come in here and distort the numbers of people and pretend that suddenly they are the friends of those hundreds of thousands of people who cannot afford dental care. Week after week, we sat in this parliament and were lectured by the previous government, who said that this was all the states’ fault and they were not going to do anything about it. We are going to play our part in fixing this problem. We are going to do it with the state and territory governments, and we are going to do it with the support of families that we will be assisting.

I also want to make clear to the member opposite, who seems to take great glee in the fact that private health insurance premiums were increased by 4.99 per cent, that we take no joy in that fact. Of course we know that this hurts people. Any increase, in the current environment, hurts people. But my obligation under the legislation, as the Minister for Health and Ageing, was to assess what the minimum increase necessary was—something that the previous minister for health never did. He always just rubber stamped—tick and flick—and approved any sort of increase that was put before him. And, while the shadow minister is swanning around complaining about the premium increase this year, I might remind the member opposite that the cumulative figure of the increase in private health insurance premiums over the life of the previous government was 89.24 per cent. Again, do not come in here in opposition and lecture us on the period of your government, Shadow Minister. If you would like the average, the average from 2002 is 6.7 per cent.

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

What about the 30 per cent rebate?

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

The 30 per cent rebate, as the shadow minister knows, is supported by the Rudd Labor government. It was supported at three elections, and it is being honoured, as promised, by the Rudd Labor government. I am quite happy to come in here and debate the shadow minister on any health issue that he is interested in debating, but I think, if we are going to do it, let us be honest with the community. There are choices that have to be made about the way we want to invest in our health system. There are choices that have to be made about what is setting up the system long term for the future.

We have started to build a future in the health system that people have not seen for many, many years because there was a national government that refused to be involved in long-term planning. Whether it was workforce, whether it was dental care, whether it was restructuring the relationships between the states and the Commonwealth—any example—the previous government walked away from those discussions. We are not going to walk away from those discussions. We are going to do the proper planning. We are going to make some hard decisions, of which this is obviously one, but we will be making those decisions based on how many people we can help, who are the most in need, where we are planning properly for the future and how we make sure that every health dollar, whether it is spent by the Commonwealth or spent by the states, is going to go to those who most need it—and we are going to make sure that our system is sustainable.

We can have a debate about the needs of the vulnerable, but unfortunately the members opposite do have to live by the record of their previous government. The shadow minister who now has responsibility for health has already become an expert because of his previous job and the way in which he dealt with those who were most vulnerable. If he wants to now pretend that he is the champion of the vulnerable, he has a lot of history to rewrite about what he did in Work Choices, bringing that baggage with him to this health portfolio. So do not come in here and lecture us about the choices that we have made that are going to help millions of Australians to get better dental care and that are going to set up a system long term that will be sustainable and will ensure that everybody into the future gets the access to the health care they need, because people—as the Prime Minister has said—simply will not believe you, Shadow Minister. They simply will not believe you.

There are many other things that we are proud of that already, in our first 100 days, we have provided in health care. This is the first time ever that the Commonwealth government has put money into reducing elective surgery waiting lists around the country. That decision of the Rudd Labor government is going to benefit 25,000 people.

Joe Hockey (North Sydney, Liberal Party, Manager of Opposition Business in the House) Share this | Link to this | Hansard source

Give us the formula.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

I love the shadow minister on this. He really wants to know how we made the decision about where the money was to go between the different states. I know why you are so intrigued about this. The process that we used to work out where the money would go is called negotiation. It is a process that is a mystery to those sitting opposite, because both the previous ministers, who were just zealots about industrial relations, have never heard of negotiation. They do not know what negotiating with the states is about. It is not a secret. It is not a secret that we were prepared to sit down with our state and territory colleagues, look at their population needs, look at their waiting lists, look at the money that there was and actually negotiate with them. There is nothing wrong with doing that. There is nothing wrong with sitting around a table and talking to state and territory health ministers about how together we will help hundreds of thousands of people around the country. That is what we did. I understand why it is a mystery to you, but I will tell you: it is delivering a lot more for working families.

Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

I am in awe—maybe I am gobsmacked—about what I have just heard coming from the Minister for Health and Ageing at the dispatch box. The fact is that the program that we speak of was not in place for four years. It is simply not true to say that is the case. In fact, the minister’s own department has come out and, in a ‘Notice to general practitioners’, told them:

Discontinuation of the Medicare Dental Items for People with Chronic Conditions and Complex Care Needs (Items 85011-87777)

... introduced by the previous government in November 2007, are to be withdrawn from the Medicare Benefits Schedule.

It was not four years.

When the Health Insurance Amendment (Medicare Dental Services) Bill 2007 was introduced into this House I welcomed it. I said:

This bill provides some much needed services. From 1 November 2007 new dental items will be introduced to the Medicare Benefits Schedule.

It is simply not true to state, Minister, that this program has been running four years and is a dismal failure. She told, in fact, another slight untruth. The minister stated at the dispatch box that a GP referral would continue to allow access to this program until 30 June 2008, when the department, on issuing the above advice to general practitioners, quite clearly outlines:

A GP referral dated before 30 March 2008 is not, by itself, sufficient for a patient to be considered to have commenced treatment.

That is a fact; that is what the department has put out. Referrals have been declared not, by themselves, to be ‘sufficient for a patient to be considered to have commenced treatment’.

The serious thing is that the minister thinks that three months, from the end of March to the end of June, is enough to overcome the waiting lists in rural and regional Australia. If the minister thinks that three months is sufficient to do that in the electorates of Riverina, Cowper and many others—I think the quote was ‘in consultation it was considered sufficient time for people to get adequate treatment under this program’—then she is seriously, seriously out of touch.

The other issue is that these people, as the minister has just indicated, are obviously going to be forced into a state and Commonwealth system, when it is a fact that only 10 per cent of the dentists are in the state system. There is no hope for people who are currently suffering because of this shortage. In the last few days, forward estimates have been declared to be not an issue, although they were an issue to the extent that if the forward estimates did not include the carers bonus then the carers bonus certainly would not be guaranteed. But isn’t it funny that, over the years, what we had coming from the other side of the House—when we were in government and the current government were in opposition—was the constant cry about the Keating dental program? They said: ‘Remember that rotten government that was over there?’—the past government—‘They slashed the Keating dental program. They tore it away; they took it away; they removed it from the Australian people.’ But it did not matter that that was not in the forward estimates. It did not matter that it was a sunset program, to sunset in 1996. There was nothing in the forward estimates—isn’t that the funny thing? It is not ‘do as I do’; it is ‘do as I say.’ There is one rule for one and one rule for the other. When you were in opposition, it was amazing that it was slashed and not in the forward estimates. Now you are on this side of the House, it does not matter that things are not in the forward estimates: ‘If it’s not there, then we don’t have to fund it. Thankfully, it wasn’t in the forward estimates.’ That is a serious issue.

I would like to bring to the minister’s attention a letter that I have received. I can honestly say I do not know the lady who has written to me, but she has clearly identified the issue that we are discussing here today and that I am very concerned about along with the information that has been delivered at the dispatch box that is not correct. It says:

Dear Mrs. Hull

Attached is Minister Nicola Roxon’s office response(5/3/08) to my enquiry re what will happen when the MBS Dental Items are discontinued on June 30 2008. That Ministers office stated that only 15,000 people had taken up the services. I replied this program had only been in operation since November 1^st 2007—not 4 years as incorrectly stated on their correspondence—

Again, the minister is putting out incorrect information. The correspondence continues:

The Federal Government quietly announced changes to the MBS Dental program on Sunday March 2nd. The decision to drop the MBS Dental item numbers will spell extreme difficulty for people who were at last able to access a huge range of dental services—including basic care through to bridge work and prosthesis—from their local dentist.

There is nothing in the press release from Minister Nicola Roxon that convinces me that her proposal is equal to or better than, the $4250/2yr program that started last November 1st 2007—

not four years ago, and it says:

The Medicare November 07 Dental program has been the best program for managing the dental care of people of all ages with a chronic disease. ... it has been an inclusive program—

Remember, I do not know this person; I do not know the person’s politics or who it is—

This program has been open to children and adults ... able bodied and disabled alike and has been taken up by the local Dentists. It means local people get access to local Dentists. The patient doesn’t have to be in dental crisis to get access to dental care ... the care is planned with better patient outcomes ... the patient isn’t forced to access a public hospital dental clinic ... and wait years for minimal treatment. The 2007 Medicare Care Plan program puts responsibility on all the participants to work towards the best health outcome for the patient—and it gives the patient control over the process—treats people with respect.

$150 voucher per annum per 12-17 year old, is not really going to do much to assist the (dare I say it) “Working families”

Dentists that I have talked with, who participated in a Commonwealth Dental Service “voucher” scheme, say it didn’t work for a number of reasons.

If, after confirming my advice to you, you feel as incensed as I that this program will go, then please, ask the question of the Minister ... What happens to those who maybe part way through their treatment—

The minister has already given us a non-factual answer at the dispatch box by saying that, if you had a referral from a doctor, you would be able to access your treatment until June 2008. In fact, her own department, in the correspondence it has sent out, says that is not the case. The correspondence continues:

And now anxious and distressed—they may not have the financial ability to complete their dental treatment ... the Minister needs to know what the end result will be for this section of the community ... the group that GP’s and Nurses manage with Chronic Diseases and dental needs, come July 08 Will country people be forced back onto regional public hospital/Dental clinic waiting list???

Judging by the response from the minister at the dispatch box, obviously they will. I repeat: only 10 per cent of dentists are working in the public health service. We are trying to address a very serious issue. It should not be addressed in a smoke and mirrors way. It needs to have truth and fact provided. (Time expired)

Amanda Rishworth (Kingston, Australian Labor Party) Share this | Link to this | Hansard source

I am surprised at the opposition’s proposal for discussion as a matter of public importance: the need to provide the most vulnerable people access to adequate health care and health services. The previous Howard government’s record was poor. I would describe the previous government’s action as malaise at best. On their watch the number of GPs decreased significantly. In some areas of my electorate of Kingston there is one GP per 5,000 people. This means that many people are waiting up to three or four weeks to see a GP. If you cannot get in to see a GP, how are you going to access other services—specialist services, dental services and even allied health services like psychologists? The number of GPs has been declining over the last 11 years and the previous government did nothing about it.

The stories that I heard as I went around the shopping centres and the electorate were very clear. People wanted something done about GP numbers. In addition, they wanted something done about the decrease in bulk-billing services. I heard story after story of people who knew something was wrong with them but they could not afford to go to the doctor because of the lack of bulk-billing services in the electorate—that was if they could actually make an appointment to see their local doctor. The previous Howard government did not pay any attention to GP numbers or GP services and left the most vulnerable people at risk.

Then there are the elective surgery waiting lists. A significant number of people in my electorate who need new hips or knees have complained to me about how long they have had to wait. This has had a significant impact on their lives. They have not been able to exercise and engage in other preventative health strategies to maintain their general health. This is causing chronic long-term problems for them and their families. Often they rely on their families and friends to look after them. The previous Howard government did nothing about elective surgery waiting lists. It walked away and left people waiting for up to four years. It left the most vulnerable people unable to access this vital surgery.

In addition, as has been the general conversation here today, public dental waiting lists have grown enormously over the last 11 years. I visited Noarlunga, where the local dental service operates, and spoke to the people in the queue. They had waited months to get the first initial check and had been waiting years for treatment. They were frustrated and annoyed. One woman told me that she had had one treatment and required another treatment and she went to the back of the queue, waiting another two years to have her teeth checked. She did not have a chronic condition; she just had bad teeth and could not afford to see a dentist.

The previous Howard government ignored the plight of those people in our community who needed dental health care. They ripped the guts out of the Commonwealth dental health system and, as a result, many vulnerable people in our community cannot afford to go and see a dentist. They do not have a chronic condition but live with teeth problems which have exacerbated health issues and also psychological issues. A number of people said to me not having their teeth fixed not only upset them in terms of their health care but lowered their self-esteem. They were feeling vulnerable because they did not have the confidence to talk with people and get on with their lives. This has had a significant impact on people. On the Howard government’s watch, the public dental waiting list and the public dental health scheme were neglected.

Over the years the Howard government also reduced its funding to the states when it came to public hospitals. It did not index the amount of funding and did not adjust for inflation. As a result, the funding went, on average, from a contribution of 45 per cent to 41 per cent. This has left the states struggling, and electors in my area have made it clear that they want contributions from the Commonwealth. They have been very clear about this. They know that Mr Howard and his government let them down when it came to health care. They are very pleased that Labor have started discussing with the state governments how we can best cooperatively improve health care.

The Liberal Party has always been pushing towards full privatisation of the health system—a user-pays system, an Americanised system—where the doctor will ring the insurer before they undertake treatment. We have seen the other long-term planning of the Liberal Party and the previous Liberal government when they talked about the boards that were going to run their hospitals. They were going to have local boards to run their hospitals; that was their first policy position. Local boards were going to be paid, then they realised how much money that would cost, so they were voluntary local boards. This was no real planning; it was flip-flopping on health care and not talking about services on the ground. In contrast, Labor has a clear and long-term plan to ensure that we have adequate health care in this country and that it reaches the most vulnerable people.

Labor have announced GP superclinics, and I am very lucky to have one in my electorate. This initiative will provide adequate infrastructure to attract GPs to areas of need. It will focus on prevention and lessen the burden of disease. It will be intrinsically involved in training GPs so that we can boost GP numbers and ensure that they are servicing our communities. It will integrate allied health care, which is so important, to ensure that we are providing a holistic program when it comes to health care. It will include psychologists, podiatrists and physios. But the most important thing about these GP superclinics is they will be a localised response, responding to the community’s needs when it comes to health care.

In South Australia the state government has a model of a GP Plus clinic, similar to a GP superclinic. We have found that in the postcode where the GP Plus clinic is there is a 13 per cent reduction of presentations to the accident and emergency unit at the local hospital. This is a real improvement in ensuring that people are getting treatment when they need it and are not overburdening the hospital system.

In the last election, Labor announced—as the Minister for Health and Ageing has already mentioned—a big elective surgery package which will fundamentally reduce waiting lists. In South Australia we received in excess of $13 million, and many electors in my electorate have welcomed that. They see this as a true contribution to cooperative arrangements between the state and the Commonwealth governments and they believe it will make a difference.

In South Australia, in addition to addressing GP shortages, during the election the Rudd Labor government pledged $10 million to the Flinders Medical Centre to improve their training facilities. I am pleased that we will be honouring that promise by ensuring that the training facilities for medical students at Flinders Medical Centre, at Noarlunga medical centre and at the Repatriation General Hospital will be expanded so that we can train more doctors.

In addition, Labor has announced a dental care plan which will invest millions of dollars to address the problem of public waiting lists. It will ensure that those most needy will be able to get dental care. We are also taking a very proactive stance on preventative health. I am pleased about this, because the Howard government did nothing when it came to preventative health. We are looking at preventative dental care for teenagers; we are looking at tackling binge drinking. These are both examples of preventative strategies, which were neglected under the Howard government. This is very important in ensuring that not only the burden of cost in health is reduced but also people live happier, healthier lives.

Labor are also doing a huge amount of work in encouraging nurses to get back into the workforce. Many nurses have left the workforce and it is important that we do attract them back. As I have mentioned before, we have a genuine commitment to work with the states to deliver the next funding agreement, ensuring that public hospitals are adequately funded. States will need to establish that the money is being spent well and that they are providing satisfactory outcomes.

I am disappointed that the shadow minister for health is not here to hear this. I would like to take this last moment to commend the minister for health on her proactive stance and commitment to health and also on turning up to debates on time, which is something that the previous health minister failed to do. I do commend the minister for— (Time expired)

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

It is good to see that ending the blame game lasted about 11 milliseconds under the new regime! The dental care plans of 1996 were concocted by desperate Prime Minister Keating at the time, when we had reached that economic abyss, that dropping away abyss of $10 billion budget deficits. He dreamt up a tokenistic dental plan. For those on the other side who have probably long forgotten how small that plan was, it was only a fraction of what it cost to deliver dental services in this country. He, nonetheless, went ahead with it while he was looking at gaping budget deficits. Of course, it was not continued, because we had to get Australia’s economy back on track, and that was done over 12 years. Those on the other side will also have probably forgotten that in that dental plan we saw costs shifting straight out of the state dental programs as the federal money came in. So the extra dental services barely registered a blip on the waiting lists. Then remember that, while I cannot quote the Constitution, saying who is responsible for dental care, what we really had were state dental programs, Member for Kingston, run by the South Australian government with their emblem on it. Were you looking, while you were speaking, at who was providing the services? They were state government dental professionals. As they went around to the schools in dental vans, they had the South Australian emblem on the dental trailers. It was so obviously a state government service. In Queensland I saw it firsthand as they wound up the services.

I was called on Monday by Mrs J. from Cleveland, who said, ‘I used to get emergency state dental services at Redlands hospital but I’ve been told the rules changed.’ While our Prime Minister is flagging the ‘teeny’ dental plan, which involves a spit and polish and no serious treatment provided by the government for genuine dental needs, your state colleagues—your Labor mates—are simply winding up the state services. They are doing that as Mr Rudd comes in waving the flag for the new federal government. We have services disappearing at Redlands hospital; emergency services are vaporising. If you have a shattered molar, you simply join the months-long queue and hope something happens. I have got news for you: a waiting list on a state hospital service is usually a holding pattern. You either stay there forever and get gazumped by more urgent cases, you go private or you pass away. That is the reality for some of these waiting lists. We see that in Queensland reported in the public hospital stats, which were all fudged before they were released by the state government in the Queensland public hospital performance report 2006-07. Elective surgery lists at the Gold Coast have virtually ground to a halt.

I am effectively wasting my time here reading out the achievements of the last 12 years—of the safety nets in PBS and MBS, of the huge shift of everyday Australian families to private health insurance. That is something that you have shown no support for. Of course, you nod to survive politically that you support PHI but you have never demonstrated any commitment to that policy. You did that in 1996 when we had the incentive scheme, in 1997 when we had the 30 per cent rebate raised to 40 per cent for seniors and in 2000 when we had Lifetime Health Cover. Minister for health, that is what shifted ordinary Australian families. It shifted 44.8 per cent of them—nearly 50 per cent of West Australians, and I can see the member for Stirling nodding, and 44 per cent of Queenslanders—to private health because they simply could not trust your colleagues at state level to run a health system. This blaming we all agreed was going to stop, but in the end the enormous injection of GST revenues did not register a blip in services at the state level. You may not have any experience in business. I notice that the member for Werriwa has disappeared, but he has some background in small business. The internal rate of return for giving federal money to your state colleagues is effectively zero. It will be very hard for you ever to get up here and justify the performances of your state governments when it comes to dental care.

The options for people really were to get private cover or to go away. That is effectively how they were treated. Many of you simply coalesced up from your state regimes to find a seat here when you realised there was a chance of being in government. But, in reality, where did you come from? You came from state regimes that would not support basic state dental care. We have those same issues in Indigenous Australia. We have really missed the point: most of the money that was not being delivered through Medicare services—as the minister for health will know—was part of COAG agreements with state and territory governments to ensure that dental services were delivered in the Northern Territory, not through the chronic disease item as you have described but through many other services. If you had been to Indigenous communities, you would know that dental services were being delivered. We have an enormous challenge coming to this parliament in the following days, where pornography is about to be returned and broadcast to the prescribed Indigenous communities. That will have a significant impact on the intervention. It is a very serious matter and it is one that you are supporting. (Time expired)

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

It intrigues me, coming into this place and listening to the opposition debate health care and especially dental care. For 11 years we heard silence from the other side. Continuously in this House the then opposition would ask questions about dental care, about what the government was doing and about how it was tackling the list of 650,000 people that were waiting for dental care and we heard silence. Every time it was raised—and we saw an example of this just now in the speech by the member for Bowman—they played the blame game. Again, they have reverted to that. Even in opposition, we see the blame game still being played out. For example, in a question in writing of 13 June 2006 to the then Minister for Health and Ageing, he was asked:

... will the Government reinstate the Commonwealth Dental Scheme, or introduce a comparable scheme ....

His reply was that, ‘No, the Commonwealth had no responsibility.’ He blamed the states and then continued by saying that plans to assume extra responsibility in this area were zilch. The answer was, ‘No, no way.’ He wiped his hands and walked away from it. Today we see the opposition have the audacity to come in here and, as the minister said earlier, try and lecture the government on dental care. We constantly raised the issue of dental care, day in and day out, in the three-year term that I was here and constantly we heard the same answer. The answer was: ‘We wipe our hands of it. It’s not our responsibility.’ Then they would go on to blame the states. Even in opposition, even from the bowels of opposition, today we see the them again engaging in the blame game. That is instead of working together with the states and ensuring that we work hand in hand and complement one another in all ways wherever we can, especially in areas where the most vulnerable are in need. This is an area where the most vulnerable are in need.

The difference between their policy and our policy is that our policy, the $290 million policy, will give one million people the ability to see a dentist. Those one million people otherwise would not have the ability to see a dentist. Their policy was for people with chronic illnesses only. If your grandmother, who was aged in her 90s, needed new dentures but did not have a chronic illness, she would not have been able to access that scheme. The numbers are easy; we can all count. This policy means one million consultations. Compare that to the previous policy, where very few people met the criteria and were able to gain access.

What we on this side of the House are doing in government is ensuring a modern health system for a modern Australia. We need to ensure that we have reforms in place. The former government continuously, for 11 years, refused any form of reform to health. They were not interested in any sort of reform. It gives me great pleasure to be able to speak on the many initiatives that this new government is putting in place to ensure that the most vulnerable Australians have adequate access to health care. This Labor government recognises the need for greater investment in and reform of Australia’s health system. Over the last decade, we saw the amount of Commonwealth investment in health services drop; it dropped entirely across the nation for 11 years. Australians were left without the health services they required and the focus of the former Liberal government was on acute rather than preventative health care. The dental scheme for teenagers that the minister spoke about earlier is all about preventative measures. In the long term it will cost governments a lot less.

Like many countries around the world, Australia faces growing pressure on its healthcare industry due to our ageing population and changes in the delivery of healthcare services. The government is therefore faced with the daunting task of rebuilding our health system so that it can effectively service the needs of all Australians—especially those in greatest need—for decades into the future. This government has hit the ground running in the area of health care, delivering $2.5 billion of election commitments in the first few months of its new term. All of the announced initiatives have been designed to improve our healthcare system in the areas of greatest need. The government has demonstrated a commitment to invest in both preventative care and acute care as two separate aspects of our health system. The announced initiatives include many things—for example, allocating $150 million in federal funding to assist 25,000 patients, who otherwise would be sitting and languishing on waiting lists, to receive the elective surgery that they need by the end of 2008. By still working within the funding framework, it will deliver long-term— (Time expired)